Provider Demographics
NPI:1639549355
Name:KEENAN, ALBERT SCOTT (LMHC)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:SCOTT
Last Name:KEENAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BROADWAY ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6065
Mailing Address - Country:US
Mailing Address - Phone:575-370-3096
Mailing Address - Fax:
Practice Address - Street 1:215 W BROADWAY ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6065
Practice Address - Country:US
Practice Address - Phone:575-370-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0174721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health